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. 2017 Sep 26:9:195-202.
doi: 10.2147/RRU.S143865. eCollection 2017.

Risk factor assessment in high-risk, bacillus Calmette-Guérin-treated, non-muscle-invasive bladder cancer

Serge Holz #  1 , Simone Albisinni #  1 , Jacques Gilsoul  1 , Michel Pirson  1 , Véronique Duthie  1 , Thierry Quackels  1 , Marc Vanden Bossche  1 , Thierry Roumeguère  1
Affiliations

Risk factor assessment in high-risk, bacillus Calmette-Guérin-treated, non-muscle-invasive bladder cancer

Serge Holz et al. Res Rep Urol. .

Abstract

Objective: To assess the risk factors associated with recurrence, progression and survival in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with bacillus Calmette-Guérin (BCG) and validate the European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) scores.

Patients and methods: We retrospectively analyzed all BCG-treated NMIBC patients from 1998 to 2012. Multiple variables were tested as risk factors for recurrence-free survival and progression-free survival (PFS). Variables included age, sex, grade, stage, tumor size, number of tumors, carcinoma in situ (CIS), recurrence status, BCG strain used, smoking status, use of re-staging transurethral resection and use of single immediate postoperative instillation. We also tested the accuracy of EORTC and CUETO scores in predicting recurrence and progression.

Results: Overall, 123 patients were analyzed. Median (interquartile range) follow-up was 49 months. The 5-year overall survival, cancer-specific survival, recurrence-free survival and PFS were 75.0%, 89.3%, 59.4% and 79.2%, respectively. On univariate analysis, multiple tumors (≥3), concomitant CIS and smoking influenced recurrence. Regarding progression, multiple tumors, concomitant CIS and Connaught strain (vs Tice) negatively influenced PFS on univariate and multivariate analyses were independent prognostic factors. CUETO scores were accurate, with a slight overestimation, while EORTC score was not predictive of recurrence or progression.

Conclusion: In this study, CIS and tumor multiplicity were unfavorable predictors of recurrence and progression in patients with NMIBC receiving BCG. CUETO model was superior to EORTC risk tables in predicting recurrence and progression in our BCG-treated patient population. Nonetheless, both scores overestimated recurrence and progression rates. Prospective trials are needed to validate our findings.

Keywords: BCG; bladder cancer; progression; recurrence.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Recurrence according to EORTC score. Abbreviation: EORTC, European Organization for Research and Treatment of Cancer.
Figure 2
Figure 2
Progression according to EORTC score. Abbreviation: EORTC, European Organization for Research and Treatment of Cancer.
Figure 3
Figure 3
Recurrence according to CUETO score. Abbreviation: CUETO, Spanish Urological Club for Oncological Treatment.
Figure 4
Figure 4
Progression according to CUETO score. Abbreviations: MI, muscle invasive; CUETO, Spanish Urological Club for Oncological Treatment..
See this image and copyright information in PMC

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